Provider Demographics
NPI:1891916797
Name:HAELY CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:HAELY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAELY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-838-5755
Mailing Address - Street 1:7500 TOWN CENTRE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-4009
Mailing Address - Country:US
Mailing Address - Phone:440-838-5755
Mailing Address - Fax:
Practice Address - Street 1:7500 TOWN CENTRE DR STE 300
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-4009
Practice Address - Country:US
Practice Address - Phone:440-838-5755
Practice Address - Fax:440-838-5766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3160111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU86546Medicare UPIN
OHSP02401Medicare ID - Type Unspecified